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. 2025 Sep 23:16:1665720.
doi: 10.3389/fendo.2025.1665720. eCollection 2025.

The use of thyroid hormones in the treatment of euthyroid patients with treatment-resistant depression. Data from a survey of 5695 European national endocrine professional organization members

Stephen Ludgate  1   2 , Anne McGowan  1   2 , Carla Moran  3   4   5 , Roberto Attanasio  6 , Miloš Žarković  7 , Endre Vezekenyi Nagy  8 , Roberto Negro  9 , Enrico Papini  10 , Chagit Adler Cohen  11 , Ersin Akarsu  12 , Maria Alevizaki  13 , Göksun Ayvaz  14 , Tomasz Bednarczuk  15 , Biljana Nedeljković Beleslin  7 , Eszter Berta  8 , Miklos Bodor  8 , Anna Maria Borissova  16 , Mihail Boyanov  17   18 , Camille Buffet  19 , Maria-Cristina Burlacu  20 , Jamina Ćirić  7 , Juan J Díez  21   22   23 , Harald Dobnig  24   25 , Valentin Fadeyev  26 , Benjamin C T Field  27 , Eric Fliers  28 , Dagmar Führer-Sakel  29 , Juan Carlos Galofré  30   31 , Tommi Hakala  32 , Jan Jiskra  33 , Peter A Kopp  34 , Michael Krebs  35 , Michal Kršek  33 , Martin Kužma  36 , Ivica Lazúrová  37 , Laurence Leenhardt  19 , Vitaliy Luchytskiy  38 , Miguel Melo  39 , Saara Metso  40 , Tatyana Morgunova  26 , Dan Alexandru Niculescu  41 , Božidar Perić  42 , Tereza Planck  43 , Catalina Poiana  41 , Francisca Marques Puga  44 , Eyal Robenshtok  45 , Patrick Rosselet  46 , Marek Ruchala  47 , Kamilla Ryom Riis  48 , Alla Shepelkevich  49 , Mykola D Tronko  50 , Jacob Stampe Frølich  48 , David Unuane  51 , Irfan Vardarli  52   53 , W Edward Visser  54 , Andromachi Vryonidou  55 , Younes Ramazan Younes  56 , Elena Yurenya  57 , Petros Perros  58 , Laszlo Hegedüs  48
Affiliations

The use of thyroid hormones in the treatment of euthyroid patients with treatment-resistant depression. Data from a survey of 5695 European national endocrine professional organization members

Stephen Ludgate et al. Front Endocrinol (Lausanne). .

Abstract

Purpose: Treatment-resistant depression (TRD) is most commonly defined as depression that has not responded to two different pharmacological agents used for an adequate period of time. We explored the views of European specialists via survey, regarding the use of thyroid hormone (TH) in euthyroid patients with TRD as part of 'Treatment of Hypothyroidism in Europe by Specialists: An International Survey' (THESIS).

Methods: The question "Thyroid hormones may be indicated in biochemically euthyroid patients with treatment resistant depression" was posed to specialists from 28 countries.

Results: 5695 valid responses were received following 17,232 invitations (33.0% response rate; 65% female, 90% endocrinologists). 348 (6.1%) stated that TH may be indicated in biochemically euthyroid patients with TRD. This view was more common in males (p<0.01), respondents who saw ≥100 patients with hypothyroidism per year (p<0.01), respondents who worked in private practice (p=0.05) and respondents who were not members of international specialist associations (p=0.05). Geographical variation existed with respondents in Eastern Europe significantly more likely to use TH in TRD (p<0.01). Linear regression showed a statistically significant reduction in the use of TH for TRD with increasing gross national income (F-statistic=7.35, CI -0.15 - -0.02, p=0.01). TH in TRD was recommended in psychiatry guidelines but not endocrinology guidelines.

Conclusion: While there is limited evidence for their use, over 6% of respondents stated that TH may be indicated in TRD. Due to the risk of iatrogenic thyrotoxicosis and increased morbidity the use of TH should be addressed in relevant endocrinology guidelines and consensus should be reached between specialties.

Keywords: TRD (treatment-resistant depression); levothyroxine; liothyroinine; thyroid; thyroid hormone.

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Conflict of interest statement

LH, PP, EP, EN and JG received consultancy fees from Institut Biochimique SA. Author IV was employed by the company Klinikum Vest GmbH Knappschaftskrankenhaus Recklinghausen. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Bar chart showing positive responses by country, ranked from highest to lowest. Serbia leads with the highest percentage, followed by Bulgaria and the Slovak Republic. Italy has the lowest percentage. The x-axis represents percentage of positive responses, with a red dashed line showing the mean positive response rate of 6.1%.
Figure 2
Figure 2
Bar graph titled “Positive Responses by Region” shows positive response percentages for five regions: Western Europe, Northern Europe, Western Asia, Southern Europe, and Eastern Europe. Eastern Europe has the highest percentage, above a red dashed line representing the mean positive response rate of 6.1%.
Figure 3
Figure 3
Scatter plot showing the relationship between antidepressant prescription rates and thyroid hormone prescription rates in biochemically euthyroid patients with TRD. The x-axis represents antidepressant prescription rates per 1,000 people, and the y-axis represents the percentage of thyroid hormone use in TRD.
Figure 4
Figure 4
Scatter plot showing the relationship between thyroid hormone levels in TRD and GNI in thousands of USD.
See this image and copyright information in PMC

References

    1. Negro R, Attanasio R, Nagy EV, Papini E, Perros P, Hegedüs L. Use of thyroid hormones in hypothyroid and euthyroid patients; the 2019 Italian survey. Eur Thyroid J. (2020) 9:25–31. doi: 10.1159/000502057, PMID: - DOI - PMC - PubMed
    1. Borissova A-MI, Boyanov M, Attanasio R, Hegedüs L, Nagy E, Negro R, et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* questionnaire survey of Bulgarian physicians. Endocrinologia. (2020) 25:299–309., PMID:
    1. Niculescu DA, Attanasio R, Hegedüs L, Nagy EV, Negro R, Papini E, et al. Use of thyroid hormones in hypothyroid and euthyroid patients: A thesis* Questionnaire survey of Romanian physicians* Thesis: treatment of hypothyroidism in Europe by specialists: an international survey. Acta Endocrinol (Bucharest). (2020) 16:462. doi: 10.4183/aeb.2020.462, PMID: - DOI - PMC - PubMed
    1. Bednarczuk T, Attanasio R, Hegedüs L, Nagy EV, Negro R, Papini E, et al. Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* questionnaire survey of Polish physicians.* THESIS: Treatment of hypothyroidism in Europe by specialists: an international survey. Endokrynol Polska. (2021) 72:357–65. doi: 10.5603/EP.a2021.0048, PMID: - DOI - PubMed
    1. Riis KR, Frølich JS, Hegedüs L, Negro R, Attanasio R, Nagy EV, et al. Use of thyroid hormones in hypothyroid and euthyroid patients: A 2020 THESIS questionnaire survey of members of the Danish Endocrine Society. J Endocrinol Invest. (2021) 44:2435–44. doi: 10.1007/s40618-021-01555-y, PMID: - DOI - PMC - PubMed

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